Incidence and Risk Factors of Stroke or Systemic Embolism in Patients With Atrial Fibrillation and Heart Failure　― The Fushimi AF Registry ―

Iguchi, Moritake; Tezuka, Yuji; Ogawa, Hisashi; Hamatani, Yasuhiro; Takagi, Daisuke; An, Yoshimori; Unoki, Takashi; Ishii, Mitsuru; Masunaga, Nobutoyo; Esato, Masahiro; Tsuji, Hikari; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Lip, Gregory Y.H.; Akao, Masaharu

doi:10.1253/circj.cj-17-1155

Cited by 28 publications

(22 citation statements)

References 30 publications

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“…In the pooled analysis of data from J-RHYTHM Registry, Fushimi AF Registry, and Shinken Database [4], age ≥ 75 years, HT and history of stroke/TIA emerged as independent predictor of ischemic stroke for Japanese patients with NVAF not using anticoagulants. Furthermore, the Fushimi AF Registry reported that not only age and history of stroke, but also unstable heart failure (HF) (within 30 days after hospitalization due to HF), type B natriuretic peptide (BNP) level, or N-terminal fragment of the prohormone B natriuretic peptide (NT-pro BNP) level were independent risk factors [20].…”

Section: Discussionmentioning

confidence: 99%

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Sakuma

Uchiyama

Atarashi³

et al. 2019

Heart Vessels

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For Japanese patients with non-valvular atrial fibrillation (NVAF), the risk of stroke and major bleeding events was assessed by using the CHADS2, CHA2DS2-VASc, and HAS-BLED scores. The risk factors for embolism and major bleeding under DOAC may be different from current reports. We analyzed the data set of the EXPAND Study to determine the risk factors for events among Japanese NVAF patients in the era of direct oral anticoagulant. Using the data of EXPAND Study, the validity for predictability of the CHADS2, CHA2DS2-VASc, and HAS-BLED scores was identified using the receiver operating characteristic curve analysis. Multivariate analysis was performed with the Cox proportional hazard model to determine the independent risk factors for stroke/systemic embolism and major bleeding among NVAF patients receiving rivaroxaban. Explanatory variables were selected based on the univariate analysis. A total of 7141 patients (mean age 71.6 ± 9.4 years, women 32.3%, and rivaroxaban 15 mg per day 56.5%) were included. Incidence rates of stroke/systemic embolism and major bleeding were 1.0%/year and 1.2%/year, respectively. The multivariate analysis revealed that only history of stroke was associated with stroke/systemic embolism (hazard ratio 3.4, 95% confidence interval 2.5-4.7, p < 0.0001). By contrast, age (1.7, 1.1–2.6, p = 0.0263), creatinine clearance (CrCl) 30–49 mL/min (1.6, 1.2-2.2, p = 0.0011), liver dysfunction (1.7, 1.1–2.8, p = 0.0320), history/disposition of bleeding (1.8, 1.0–3.0, p = 0.0348), and concomitant use of antiplatelet agents (1.6, 1.2–2.3, p = 0.0030) were associated with major bleeding. This sub-analysis showed that some components of the HAS-BLED score were independently associated with major bleeding in Japanese NVAF patients receiving anticoagulation therapy by rivaroxaban. Additionally, CrCl value of 30–49 mL/min was an independent predictor of major bleeding in patients receiving rivaroxaban.

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Section: Discussionmentioning

confidence: 99%

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Sakuma

Uchiyama

Atarashi³

et al. 2019

Heart Vessels

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“…The Fushimi AF Registry demonstrated that although heart failure at enrollment was not significantly associated with incidence of stroke, patients admitted who experienced heart failure after enrollment, or those with a high BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal pro-B-type natriuretic peptide) level, were at a risk for stroke. 18 Furthermore, the Hokuriku-Plus AF Registry demonstrated that high BNP level was significantly associated with future thromboembolic events. 11 These findings strongly suggest that the effect of heart failure on the incidence of stroke is dependent on the stage or severity of heart failure.…”

Section: Risk Factors In Chads 2 Scorementioning

confidence: 99%

Risk Factors Associated With Ischemic Stroke in Japanese Patients With Nonvalvular Atrial Fibrillation

et al. 2020

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“…This might have reduced the AF burden, which resulted in an excellent outcome. Iguchi et al demonstrated that patients with preexisting heart failure had higher unadjusted rates of strokes/SEs (HR, 1.40; 95% CI, 1.05‐1.85; P = .02 by a log‐rank test) as well as higher incidences of all‐cause death and a composite of all‐cause death or strokes/SEs . Although AFCA history could not be associated with strokes/SEs in the HAF‐NET registry, we could clearly demonstrate that the AFCA history could be associated with the lower cardiovascular hospitalization, which indicated that the possibility improving the higher strokes/SEs as well as higher incidences of all‐cause death and a composite of all‐cause death or strokes/SEs.…”

Section: Discussionmentioning

confidence: 99%

One‐year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF‐NET) Registry

Hyogo

Yoshida

Takeuchi

et al. 2019

Journal of Arrhythmia

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Background Although anticoagulation therapy could reduce the risk of strokes in patients with atrial fibrillation (AF), large‐scale investigations in the direct oral anticoagulant (DOAC) and AF catheter ablation (CA) era are lacking. Methods This study was designed as a prospective, multicenter, observational study and a total of 2113 patients from 22 institutions were enrolled in the Hyogo area. Results The mean age and CHADS2 score were 70.1 ± 10.8 years old and 1.5 ± 1.1, respectively. The follow‐up period was 355 ± 43 days. CA was performed in 614 (29%) and DOACs were prescribed in 1118 (53%) patients. Ischemic strokes/systemic embolisms (SEs) and major bleeding occurred in 13 (0.6%) and 17 (0.8%) patients, respectively. New onset dementia, hospitalizations for cardiac events, and all‐cause death occurred in eight (0.4%), 60 (2.8%), and 29 (1.4%) patients, respectively. A multivariate analysis demonstrated that persistent AF and the body weight (BW) were associated with ischemic strokes/SEs and major bleeding, respectively (persistent AF: hazard ratio, 9.57; 95%CI, 1.2‐74.0; P = .03; BW: hazard ratio, 0.94; 95%CI, 0.90‐0.99; P = .02). AFCA history was associated with the cardiac events (hazard ratio, 0.44; 95%CI, 0.20‐0.99; P = .04). Age was associated with new onset dementia (hazard ratio, 1.1; 95%CI, 1.0‐1.2; P = .03). Conclusions In the DOAC and CA era, the incidence of ischemic strokes/SEs, major bleeding and cardiac events could be dramatically reduced in patients with AF. However, some unsolved issues of AF management still remain especially in elderly patients with persistent AF and a low BW.

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Incidence and Risk Factors of Stroke or Systemic Embolism in Patients With Atrial Fibrillation and Heart Failure　― The Fushimi AF Registry ―

Cited by 28 publications

References 30 publications

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Risk Factors Associated With Ischemic Stroke in Japanese Patients With Nonvalvular Atrial Fibrillation

One‐year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF‐NET) Registry

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Incidence and Risk Factors of Stroke or Systemic Embolism in Patients With Atrial Fibrillation and Heart Failure ― The Fushimi AF Registry ―

Cited by 28 publications

References 30 publications

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Clinical risk factors of stroke and major bleeding in patients with non-valvular atrial fibrillation under rivaroxaban: the EXPAND Study sub-analysis

Risk Factors Associated With Ischemic Stroke in Japanese Patients With Nonvalvular Atrial Fibrillation

One‐year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF‐NET) Registry

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Incidence and Risk Factors of Stroke or Systemic Embolism in Patients With Atrial Fibrillation and Heart Failure　― The Fushimi AF Registry ―